{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:33:55Z","timestamp":1782995635146,"version":"3.54.5"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T00:00:00Z","timestamp":1709510400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World J Urol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>The objective of this study was to perform a retrospective cohort analysis, in which we measured the association of an acute pain service (APS)-driven multimodal analgesia protocol that included preoperative intrathecal morphine (ITM) compared to historic controls (i.e., surgeon-driven analgesia protocol without ITM) with postoperative opioid use.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>This was a retrospective cohort study in which the primary objective was to determine whether there was a decrease in median 24-h opioid consumption (intravenous morphine equivalents [MEQ]) among robotic nephrectomy patients whose pain was managed by the surgical team prior to the APS, versus pain managed by APS. Secondary outcomes included opioid consumption during the 24\u201348\u00a0h and 48\u201372\u00a0h period and hospital length of stay. To create matched cohorts, we performed 1:1 (APS:non-APS) propensity score matching. Due to the cohorts occurring at the different time periods, we performed a segmented regression analysis of an interrupted time series.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>There were 76 patients in the propensity-matched cohorts, in which 38 (50.0%) were in the APS cohort. The median difference in 24-h opioid consumption in the pre-APS versus APS cohort was 23.0\u00a0mg [95% CI 15.0, 31.0] (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.0001), in favor of APS. There were no differences in the secondary outcomes. On segmented regression, there was a statistically significant drop in 24-h opioid consumption in the APS cohort versus pre-APS cohort (<jats:italic>p<\/jats:italic>\u2009=\u20090.005).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The implementation of an APS-driven multimodal analgesia protocol with ITM demonstrated a beneficial association with postoperative 24-h opioid consumption following robot-assisted nephrectomy.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00345-024-04801-z","type":"journal-article","created":{"date-parts":[[2024,3,4]],"date-time":"2024-03-04T14:03:17Z","timestamp":1709560997000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Robot-assisted laparoscopic nephrectomy: early outcome measures with the implementation of multimodal analgesia and intrathecal morphine via the acute pain service"],"prefix":"10.1007","volume":"42","author":[{"given":"Minhthy N.","family":"Meineke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew V.","family":"Losli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacklynn F.","family":"Sztain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew W.","family":"Swisher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy B.","family":"Abramson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin I.","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy J.","family":"Furnish","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amirali","family":"Salmasi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ithaar H.","family":"Derweesh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4443-0021","authenticated-orcid":false,"given":"Rodney A.","family":"Gabriel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Engy T.","family":"Said","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,3,4]]},"reference":[{"issue":"3","key":"4801_CR1","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1093\/bja\/79.3.369","volume":"79","author":"JI Alexander","year":"1997","unstructured":"Alexander JI (1997) Pain after laparoscopy. Br J Anaesth 79(3):369","journal-title":"Br J Anaesth"},{"issue":"4","key":"4801_CR2","doi-asserted-by":"publisher","first-page":"1157","DOI":"10.1213\/01.ane.0000198567.85040.ce","volume":"102","author":"L De Pietri","year":"2006","unstructured":"De Pietri L, Siniscalchi A, Reggiani A, Masetti M, Begliomini B, Gazzi M, Gerunda GE, Pasetto A (2006) The use of intrathecal morphine for postoperative pain relief after liver resection: a comparison with epidural analgesia. Anesth Analg 102(4):1157","journal-title":"Anesth Analg"},{"key":"4801_CR3","volume":"2012","author":"BB Mugabure","year":"2012","unstructured":"Mugabure BB (2012) A clinical approach to neuraxial morphine for the treatment of postoperative pain. Pain Res Treat 2012:612145","journal-title":"Pain Res Treat"},{"issue":"1","key":"4801_CR4","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1097\/00000542-199307000-00010","volume":"79","author":"PL Bailey","year":"1993","unstructured":"Bailey PL, Rhondeau S, Schafer PG, Lu JK, Timmins BS, Foster W, Pace NL, Stanley TH (1993) Dose-response pharmacology of intrathecal morphine in human volunteers. Anesthesiology 79(1):49","journal-title":"Anesthesiology"},{"issue":"4","key":"4801_CR5","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1007\/s00540-017-2356-9","volume":"31","author":"J Bae","year":"2017","unstructured":"Bae J, Kim HC, Hong DM (2017) Intrathecal morphine for postoperative pain control following robot-assisted prostatectomy: a prospective randomized trial. J Anesth 31(4):565","journal-title":"J Anesth"},{"issue":"4","key":"4801_CR6","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1177\/2049463716668904","volume":"10","author":"FA El Sherif","year":"2016","unstructured":"El Sherif FA, Othman AH, Abd El-Rahman AM, Taha O (2016) Effect of adding intrathecal morphine to a multimodal analgesic regimen for postoperative pain management after laparoscopic bariatric surgery: a prospective, double-blind, randomized controlled trial. Br J Pain 10(4):209","journal-title":"Br J Pain"},{"issue":"2","key":"4801_CR7","doi-asserted-by":"publisher","first-page":"378","DOI":"10.1093\/pm\/pnz214","volume":"21","author":"M Covotta","year":"2020","unstructured":"Covotta M, Claroni C, Costantini M, Torregiani G, Pelagalli L, Zinilli A, Forastiere E (2020) The effects of ultrasound-guided transversus abdominis plane block on acute and chronic postsurgical pain after robotic partial nephrectomy: a prospective randomized clinical trial. Pain Med 21(2):378","journal-title":"Pain Med"},{"issue":"1","key":"4801_CR8","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1186\/s12894-021-00798-4","volume":"21","author":"JW Shim","year":"2021","unstructured":"Shim JW, Cho YJ, Moon HW, Park J, Lee HM, Kim YS, Moon YE, Hong SH, Chae MS (2021) Analgesic efficacy of intrathecal morphine and bupivacaine during the early postoperative period in patients who underwent robotic-assisted laparoscopic prostatectomy: a prospective randomized controlled study. BMC Urol 21(1):30","journal-title":"BMC Urol"},{"issue":"5","key":"4801_CR9","doi-asserted-by":"publisher","first-page":"599","DOI":"10.1111\/anae.14922","volume":"75","author":"MV Koning","year":"2020","unstructured":"Koning MV, de Vlieger R, Teunissen AJW, Gan M, Ruijgrok EJ, de Graaff JC, Koopman J, Stolker RJ (2020) The effect of intrathecal bupivacaine\/morphine on quality of recovery in robot-assisted radical prostatectomy: a randomised controlled trial. Anaesthesia 75(5):599","journal-title":"Anaesthesia"},{"issue":"1","key":"4801_CR10","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1089\/end.2019.0362","volume":"34","author":"R Talwar","year":"2020","unstructured":"Talwar R, Xia L, Serna J, Ding J, Lee DJ, Ziemba JB, Guzzo TJ (2020) Preventing excess narcotic prescriptions in new robotic surgery discharges: the PENN prospective cohort quality improvement initiative. J Endourol 34(1):48","journal-title":"J Endourol"},{"issue":"1","key":"4801_CR11","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1159\/000442843","volume":"9","author":"SE Batley","year":"2016","unstructured":"Batley SE, Prasad V, Vasdev N, Mohan SG (2016) Post-operative pain management in patients undergoing robotic urological surgery. Curr Urol 9(1):5","journal-title":"Curr Urol"}],"container-title":["World Journal of Urology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-024-04801-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00345-024-04801-z\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00345-024-04801-z.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,2]],"date-time":"2025-01-02T21:21:51Z","timestamp":1735852911000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00345-024-04801-z"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,3,4]]},"references-count":11,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["4801"],"URL":"https:\/\/doi.org\/10.1007\/s00345-024-04801-z","relation":{},"ISSN":["1433-8726"],"issn-type":[{"value":"1433-8726","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,3,4]]},"assertion":[{"value":"12 July 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 March 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human or animals rights"}},{"value":"Requirement waived by institutional review board.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}}],"article-number":"117"}}